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Published by Cape Cod Healthcare, 2018-06-29 14:00:23

Cape Cod Health News - Falmouth Edition - pt2

Cape Cod Health News A News Service of
Special Falmouth Hospital Edition!


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FALMOUTH HOSPITAL
Member Cape Cod Healthcare
Volunteers
(L to R): Paul Plisinski; Lorraine Mahoney; Sandi Duxbury; and Les Wrigley


Cape Cod Health News A News Service of
We ARe FALMoutH HoSPItAL
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Patient education is key to cardiac care – featuring Megan A. Titas, MD
Do you miss dancing or walking on the beach? – featuring Donald O’Malley, MD
An aspirin a day may keep colorectal cancer away – featuring Peter Hopewood, MD, FACS
this is one of the biggest risks to your health – featuring Miguel Prieto, MD
Is arthritis unavoidable as we age? – featuring Michelle Costa, DO
Are you and your child ready for summer mishaps? – featuring Emily O’Connell, MD
think you’re too old for spinal surgery? – featuring David C. Leppla, MD
A nosebleed. A pregnancy. A team effort – featuring Douglas Mann, MD and Paul DeMeo, MD
ContentS


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the American Heart Association calls it “therapeutic Patient Education,” or TPE, in a new scientific statement that recom- mends a tailored approach to teaching heart patients how to live more comfortably with their disease.
Megan A. titas, MD, a cardiologist with the Cardiovascular Specialists in Falmouth, calls it “tLC” (tender loving care), and says she is glad there is growing scientific evidence to support what doctors innately know: there’s no such thing as one- size-fits-all medicine.
“Doctors are teachers, and we really have to listen to what each patient is saying,” she said. “Patients need as much in- formation as we can give them.
“The American Heart Association’s scientific statement sounds like common sense, but it’s based on an integrative review of the literature on tPe for self-management in cardiovascular conditions.”
Studies on tPe in patients with high blood pressure, cardiovas- cular disease, heart failure and atrial fibrillation were reviewed.
The scientific statement concluded, “It is clear that patient education alone does not work and that multiple strategies, tailored to the individual patient, are essential for self-manage- ment to be successful.”
A Team Approach
According to the American Heart Association, patients need: • Knowledge of their disease
• Self-management skills to apply this knowledge to their
daily lives
• Confidence that they can sustain self-management.
“When we take time to educate each patient in their own way, we can make it easier for patients and their families to assume more responsibility for their own self-management,” said Dr. titas. “We can engage and educate patients, let them be part of their own healthcare decisions, and help them understand why they are taking a particular medicine, therapy or other course of action.”
Patient education is key
to cardiac care
Patient-tailored care based on discussions with their doctor is essential for a good outcome, says new study.
By Beth Ann Lombardi
How can practitioners follow the American Heart Association’s recommendation, which can mean spending more time with patients?
Dr. titas answers without hesitation, “We form good working relationships and educate patients about what’s going on with their care. We have a team of people including nurses, dieti- tians, therapists and others—not just a doctor—providing each patient with the best care possible.”
Patients are the “captains of the ship,” said Dr. titas, a lieu- tenant commander in the u.S. navy who completed a six-year tour of service.
Her husband, Jeffrey Siegert, MD, also a lieutenant commander, is a general surgeon at Falmouth Hospital.
“I have a bachelor’s degrees in anthropology and biology from the university of South Carolina,” Dr. titas said. “I’ve always liked the social side of medicine that anthropology gives you. everyone is different, and I’m very interested in people on an individual basis. You have to talk with patients and figure out how to reach each one as an individual to provide the best pos- sible care, and that’s what tPe is all about.” | CCHN
Cape Cod Health News HeARt & VASCuLAR


A News Service of
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BoneS & MuSCLeS
If you have stiff or sore joints after inactivity or overuse, or mild swelling in your joints, there’s a good chance you have arthri- tis. You’re not alone. the Arthritis Foundation estimates that arthritis affects 50 million adults and about 300,000 children.
osteoarthritis, alone, affects 27 million Americans.
“there’s probably about 125 different types of arthritis, but the three most common ones are osteoarthritis, rheumatoid arthritis and post-traumatic arthritis,” explained orthopedic surgeon Donald o’Malley, MD at Cape Cod Sports Medicine in Falmouth. “If you think you have arthritis, it’s important to come in to see an orthopedic surgeon. The first thing that we’re going to do is take a history and figure out what type of arthritis we are dealing with, because every arthritis is dealt with a little differently.”
osteoarthritis, otherwise known as degenerative joint disease or the “wear and tear” arthritis, is the most common form, ac- cording to Dr. o’Malley. It is caused when the cartilage that acts as a cushion between the bones in a joint wears down over time. eventually, you will have bone rubbing on bone, which is what causes the pain and inflammation.
Rheumatoid arthritis is an autoimmune disorder that Dr. o’Malley cited as the second most common form of arthritis. Post-traumatic arthritis is arthritis that sets in years after an injury, such as a broken wrist.
“With post-traumatic arthritis, the cartilage starts wearing out because at the point of impact when you broke that wrist, you really sustained a lot of damage to that cartilage that doesn’t show up on usual X-rays,” he said. “It only shows itself years later.”
The usual first lines of treatment for osteoarthritis and post- traumatic arthritis are:
• A recommendation to not overload or overuse the joint
• No pounding type activities like running and jumping
• Injecting steroids into the joint
• Injecting a lubricating fluid into the joint to help it glide better • Aquatic therapy
Do you miss dancing or
walking on the beach?
Joint pain can affect your quality of life by forcing you to quit the activities you love. there are many treatment options.
By Laurie Higgins
“I’m a big fan of aquatic therapy and we offer it at both hospi- tals on the Cape,” Dr. o’Malley said. “An aquatic pool is very nice because you lose the effect of gravity, you have the cool- ing effect of the water, and joints move much more easily in a fluid environment. You get better motion when you are in the water than you do on land.”
Joint replacement surgery is the ultimate fix for arthritis that is painful enough to affect daily activities.
“People aren’t aware of all the joint replacements we can do,” Dr. o’Malley said. “there is a total joint replacement for just about any joint in the body.”
While some doctors recommend saving joint replacement as a last resort of treatment, as a sports medicine doctor, Dr. o’Malley prefers to do it sooner rather than later because he wants his patients to be able to enjoy the sports they love pain- free. In his experience, if a patient has given up a sport like golf, skiing or tennis for five or six years, the chances they will return to that activity after a later joint replacement surgery is quite low.
“I generally tell patients the sooner you do it, the more you maintain your lifestyle,” he said. “I like to catch patients right when they start noticing that they are not doing all the things they used to do.”
the good news is that joint replacement technology just keeps getting better. Over the past five years, orthopedic surgeons have been replacing only a portion of joints like knees, hips and shoulders, rather than the whole joint. they take out the component of the joint that is damaged, but leave the healthy alone, he said. that means a shorter surgery with a much smaller incision. Most people go home the same day.
“I’ve seen people out dancing after a knee replacement and I’ve seen people return to skiing after a knee replacement,” Dr. o’Malley said. “It’s a very rewarding surgery to do.” | CCHN


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Falmouth Hospital surgeon Peter Hopewood, MD, FACS, takes an 81 mg tablet of aspirin every day to help prevent colorectal cancer. While he concedes he takes it mainly to prevent heart problems, an added benefit is colon protection.
“Recent studies have shown aspirin to be very effective in de- creasing heart disease and also decreasing polyp formation in the bowel,” he said. “I’ve had a colonoscopy (a screening test using a scope to view the colon) and had a benign polyp, so now I’m on the five-year follow-up colonoscopy plan.”
A study published in JAMA oncology last year concluded that “regular aspirin moderately reduced the incidence of overall cancer, with more substantial benefits observed for gastroin- testinal tract cancers, especially colorectal.”
Researchers also found the risk of developing gastrointestinal cancers, including colorectal cancer, seemed to be dose-de- pendent. those taking a low-dose aspirin (81mg) seven days a week for 10 years did better than those who took higher doses of aspirin.
Dr. Hopewood recently started recommending aspirin as a preventive measure against colorectal cancer. In addition, he stresses colonoscopy and the Fecal Immunochemical test (FIt), a test that checks for blood in your stool, as important screening tools for pre-emptive care.
Screening Tests
Colonoscopies are done for two different reasons, according to Dr. Hopewood:
A prevention screening colonoscopy is done every 10 years after age 50, if you are completely well without any symptoms or blood in your stool. If your gastroenterologist finds a benign polyp and removes it, the polyp is prevented from developing into colon cancer.
Diagnostic colonoscopy is done when you have symptoms such as cramps, changes in your stool, anemia or unintended weight loss.
the FIt test is an additional diagnostic tool that can be es- pecially helpful for those who can’t tolerate the prep of the colonoscopy, can’t afford the test because it is expensive and they may not have health insurance, or it is too inconvenient.
An aspirin a day may keep
colorectal cancer away
A new study shows that aspirin can ‘moderately reduce’ the incidence of cancer, especially colorectal cancer.
By Roberta Cannon
“the American Cancer Society (ASC) now says you can do a FIt test that checks for blood in samples of your stool,” said Dr. Hopewood. “this test is done annually and if it is positive, you follow it up with a colonoscopy.”
Dr. Hopewood recommends his patients take a daily aspirin to prevent polyp growth, especially after surgery or colonoscopy to remove a malignant polyp.
“We don’t know how long it takes to develop a polyp or for a polyp to become malignant. In these circumstances, we re- move the malignant polyp with a colonoscopy or surgery, and follow-up a year later with a colonoscopy. If that shows no polyps, then we repeat colonoscopy three to five years later,” he said.
Risk Factors
While aspirin and screenings can reduce the risk of colorectal cancer, you can also make changes to the following risk factors to prevent colorectal cancer, according to the ACS:
• Obesity or being overweight
• Physical inactivity
• Diets high in red meats such as beef, pork, lamb or liver and
processed meats, such as hot dogs and luncheon meats. • Cooking meats at high temperatures
• Smoking
• Heavy alcohol use
“For the general population, we recommend good nutrition with the right foods, weight and alcohol control, and an 81 mg aspirin,” said Dr. Hopewood. “the most important is getting the FIt test or the colonoscopy.” | CCHN
Cape Cod Health News CAnCeR CARe


A News Service of
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PRIMARY CARe
Normal inflammation is a healthy immune response to injury or bacteria. If you bang your finger, it will swell and turn red. that reaction occurs because the immune system is provid- ing chemicals called oxidants that heal the injury and fight infection.
But chronic inflammation is a much more sinister problem. It has been implicated in an assortment of serious illnesses like heart disease, stroke, diabetes, autoimmune disorders and dementia.
Some people take anti-oxidant vitamins to counter that pro- cess, but internal medicine physician Miguel Prieto, MD, with emerald Physicians in Bourne said people should concentrate on lifestyle changes that prevent the chemicals from being re- leased in the first place because the oxidants cause collateral damage to other cells.
Eat a Healthy Diet
“We’re committing suicide with our forks,” he cautioned. “We’ve got to change our diet.”
An important step in reducing inflammation is to decrease the amount of foods that cause an excess of insulin to be secreted. the combination of processed starches and fat creates an envi- ronment where the body produces a lot of insulin, he said. In- sulin is a pro-inflammatory factor that also causes weight gain.
numerous studies on a wide variety of creatures from insects to humans show that those who consume fewer calories live much longer, Dr. Prieto said.
“In the DnA itself, there are these coils called chromosomes, and the end portion are called telomeres,” he said. “the length of the telomeres gets shorter every time the cell divides. So if you don’t need to divide the cells to replace them because of inflammation, you are basically prolonging life.”
A normal body repairs about 300 million cells every minute. to do so, the body has to uncoil the whole six feet of DnA in the chromosome to copy it, he said. that is the basic hu- man metabolic rate. When you add inflammation, there are a lot more cells to repair, resulting in an accumulation of small changes that create flawed copies of the cells.
this is one of the biggest
risks to your health
Chronic inflammation leads to a host of diseases and can shorten your life. our expert tells how to combat it.
By Laurie Higgins
It’s a little like making a photocopy of a photocopy of a photo- copy, Dr. Prieto explained. By the time you get to the 300th photocopy, it is not going to look as good as the original. In the body those cells are called mutations and they lead to disease.
Exercise Regularly
“Medical studies have shown that physical activity helps delay the effects of aging in our bodies,” Dr. Prieto said. “Multiple studies have shown the magical number being 150 minutes a week at about 70 percent of your maximum heart rate. Your maximum heartrate is about the number 220 minus your age.”
When you exercise, you bypass the need for insulin to get sugar inside your cell. Less insulin means less inflammation, he said. While all exercise is good, “weekend warriors” don’t see the same benefits as someone who exercises at least 20 minutes every day, because regular exercise leads to a constant lower inflammatory level in your body.
It is never too late to start exercising, Dr. Prieto said. It may take longer for an older person to build up muscle mass, but eventually they do.
The benefits are enormous. Exercise cuts the risk of dementia and Alzheimer’s disease by 50 percent, he said. elderly people who regularly exercise are also less apt to suffer from a disabil- ity and if they do get injured, they recover faster.
“It’s not just because your muscles are stronger,” he said. “You recover better because when your inflammatory levels are low- er, your body devotes less energy to repairing inflammation and has more energy to repair the injury.”
It Doesn’t Take a Gym
A big mistake that Dr. Prieto sees patients make is that they usually associate exercise with going to a gym. there are plenty of other forms of exercise that are just as healthy such as:
• Walking
• Swimming
• Cycling (with a three-wheeler, if elderly)
• Pedaling arm bikes for those whose legs don’t work well
• Dancing (especially good for those with Parkinson’s disease) • Walking on the golf course instead of taking a cart
• Bowling or curling
(continued on next page)


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Cape Cod Health News
even though federal guidelines recommend 150 minutes of exercise a week for optimal health, those with arthritis or other painful conditions may find it difficult to achieve that amount. New research shows people with arthritis can see benefits in physical functioning from even just 45 minutes of exercise a week.
“our bodies are not machines,” Dr. Prieto said. “our bodies are better than machines because they have the capacity to regenerate with stem cells. the less you change your cells with inflammation, the longer that ability lasts.” | CCHN
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A News Service of
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AgIng WeLL
“Late that same night, long after Ben had brought us home, I sat in the window seat of my room, unable to sleep. I had my right leg stretched out in front of me and occasionally bent to massage my knee. I suspected it was going to rain tomorrow; I had noticed that my knee ached worse than usual right before rain arrived.”
– “Family Ties & Thicker than Blood: The Kinnear Chronicles” (Sanofsky, 2014; ebook)
ever had the feeling you can predict changes in the weather just by the pain in your joints? You’re not alone.
that’s a phenomenon associated with osteoarthritis, the most common of the more than 100 types of arthritis, according to Michelle Costa, Do, a rheumatologist with Cape Cod Rheuma- tology Center in Falmouth.
“So many people can relate to arthritis because the disease is very common,” she said. “If you have pain, stiffness or swell- ing in your joints, bring it up with your primary care physician. they manage most arthritis patients and can tell you about your options, which might include referring you to a rheuma- tologist, orthopedist or neurologist.”
More of us are suffering from arthritis than once thought, ac- cording to new research from Boston university. A study pub- lished in Arthritis & Rheumatology revealed an estimated 91 million u.S. adults have arthritis, and one-third of sufferers are between 18 and 64 years old. those estimates are 68 percent higher than previously reported, according to the researchers.
“By far, most of us will be dealing with osteoarthritis,” said Dr. Costa. “You may hear a lot about rheumatoid arthritis be- cause it can be so debilitating, but rheumatoid arthritis only affects about 1 percent of the world’s population. Lupus ef- fects even less. osteoarthritis is a wear-and-tear arthritis that is responsible for most of the aches and pains we have as we age. osteoarthritis is also responsible for most knee and hip replacements as well as spinal stenosis.”
Most of us will start getting osteoarthritis in our late 40s or early 50s, and the disease gets worse with age, she explained.
“An example we can all relate to is friends who say they have arthritis in their shoulders from pitching baseballs when they were kids. I broke my collar bone while bicycling when I was 22, and that caused post-traumatic osteoarthritis in my shoul- der,” she said.
Is arthritis unavoidable
as we age?
osteoarthritis is more common than once thought, especially in older adults. But exercise and keeping weight off can help.
By Beth Ann Lombardi
osteoarthritis does not always follow a predictable path, according to Dr. Costa.
Treatment and Prevention
“We can X-ray 100 people over age 40, and 70 percent will have X-ray evidence of osteoarthritis, but only half of them will have symptoms. X-ray evidence does not correlate to pain. there is no cure or drug that slows its progression, but os- teoarthritis rarely disables people or shortens lives; it is just painful.”
Arthritis is a move it or lose it disease, Dr. Costa said. People who are inactive suffer more from arthritis than people who exercise regularly.
According to Dr. Costa, the best ways to prevent osteoarthritis or deal with its effects are:
• Maintain a healthy weight
• Exercise at least 150 minutes a week
“Basically, follow the same recommendations for good heart health. We say, ‘If it’s good for the heart, it’s good for the joints,’” she said.
Swimming is the best exercise for osteoarthritis, but most people don’t have easy access to swimming pools. Aerobic ex- ercise like walking is essential and muscle strengthening exer- cises like weight training and resistance training are also good for osteoarthritis, according to Dr. Costa.
“With osteoarthritis, you’ll have good days and bad days, so take non-steroidal anti-inflammatory drugs (NSAIDS) like Advil or Aleve only when necessary,” Dr. Costa said. “Cortisone in- jections are another option for some patients who experience pain relief for several months after getting the shots in one or two joints. Because exercise is so important to arthritis man- agement, physical therapists are incredibly important to many sufferers. they do a wonderful job helping patients who have arthritis of any kind.”
the question patients ask her most often is ‘What can I do to keep this from getting worse?, and she is quick to advise los- ing weight.
“obesity makes arthritis worse. Control your weight and keep exercising,” she said. | CCHN


8
You’re heading out to the beach or park on a summer’s day and the car is packed with tote bags full of items such as food, drinks, beach towels, sandals, beach toys and blankets. the bikes are on the rack and helmets are safely tucked in their spot on the floor.
the kids are ready and everything you need for a summer out- ing is good to go...or is it?
one of the most important items that could potentially save the day in case of a scrape, cut, bee sting, insect bite or sunburn, is a first aid kit.
“the more you can be prepared for accidents and injuries, the better it is,” said emily o’Connell, MD, a pediatrician at Falmouth Pediatric Associates.
A 2008 report by the Centers for Disease Control and Pre- vention (CDC) revealed that 2.8 million children were seen in hospital emergency departments from 2000-2006 and unin- tentional falls were the leading cause of injuries. the report listed other causes of injuries as being struck by or against an object, animal bites, bee stings and overexertion.
One of the first things to do in the event of an injury, insect bite or bee sting is to remain calm, according to Dr. o’Connell.
“If your child senses alarm from you, they are more likely to become alarmed themselves,” she said.
The second step is using your first aid kit.
What You Will Need
In case of an emergency, it’s important to know what is in your first aid kit and where the items are for easy access.
“When you create your own, you’ll know where everything is,” said Dr. o’Connell.
The first and most important item to have for emergencies is your cell phone, in case you need to call for help, she said.
Are you and your child
ready for summer mishaps?
A sudden injury can sideline your summer outing, so be prepared with a do-it-yourself first aid kit.
By Roberta Cannon
Other items she recommends for the most basic kit to treat injuries are:
•Band-Aids, bandages (any size) gauze pads, and an ace
bandage (any size)
• A roll of self-adhesive athletic tape, which you can use to
wrap around a bandage to keep it in place
• Antibiotic ointment for cuts
• An ice pack that you can snap to open and apply to a mus-
cular or skeletal bone injury
Products for insect bites, bee stings and sunburns:
• Hydrocortisone cream, which helps relieve inflammation and itching
• Benadryl cream to help relieve the itch of insect bites and bee stings
Oral medications in doses according to your children’s ages:
• Oral Benadryl in liquid or tablets is a medication that can stop allergic reactions. Dr. o’Connell stresses this is really important to have with you in case your child develops hives from a bee sting or other allergen, it can be life-saving
• Tylenol or Ibuprofen for pain and/or fever
Medications your child takes on a regular basis:
• Inhalers that treat asthma such as Albuterol (Dr. O’Connell recommends having your child’s inhaler with your child at all times, keeping an extra one in your car and the first aid kit.)
• Medications for diabetes
• Medications for other chronic illnesses
While it’s tempting to load up a large bag with everything you could possibly need for first aid, Dr. O’Connell cautions parents to remember they have to carry it with them.
“Size it down to the things you’ll need especially if you are hik- ing or camping,” she said. “The most helpful first aid kit is the one you have with you.” | CCHN
Cape Cod Health News CHILDRen’S HeALtH


A News Service of
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BrAIN, NECK & NErvES
the graying of America brings with it more people with degen- erative spinal conditions, including spinal stenosis and herni- ated discs. Both cause pain and weakness through compres- sion of nerves, which is known as radiculopathy.
these natural consequences of aging can be successfully treat- ed in patients, no matter what their age, according to neuro- surgeon David C. Leppla, MD, of neurosurgeons of Cape Cod practice in Hyannis. He estimated 50 to 60 percent of his Cape patients are on Medicare, for which most people become eligible at 65, and 70 to 80 percent of his practice is spine- related.
“We should let people know they shouldn’t be afraid,” to have spine surgery, he said.
For instance, in the case of a simple herniated disc in a rela- tively healthy individual over 65, surgery would entail cutting a 1.5-inch incision and the patient might go home the same day, he said.
Dr. Leppla’s comfort in treating older patients is backed up by two recent studies that examined data from the norwegian Registry for Spine Surgery. one looked at surgical outcomes for patients with a herniated or “slipped” disc. the other reviewed those with spinal stenosis.
A herniated disc occurs when one of the cushioning pads be- tween the bones of the spine, or vertebrae, bulges or leaks and presses on a nerve. Researchers at the norwegian university of Science and technology (ntnu) and St. olav’s Hospital in trondheim, norway, examined post-surgical reports from 381 patients 65 and older and 5,195 younger patients. the results were published in JAMA Surgery in May 2017. Both groups showed significant improvement.
According to the JAMA network, the two age groups did not differ in amount of disability, quality of life or leg pain after sur- gery. the older group did report greater improvement in back pain. the older group also reported longer hospital stays (2.7 days vs. 1.8 days), slightly more complications immediately after surgery (4.2 percent vs. 2.3 percent), and more compli- cations within three months after discharge (12.4 percent vs. 5.4 percent).
think you’re too old for
spinal surgery?
Age alone is not a barrier to surgical repair, according to recent studies and a neurosurgeon.
By Rich Holmes
Spinal stenosis is a narrowing of the vertical canal within the spine through which the spinal cord and nerves pass. norwe- gian researchers at ntnu, St. olav’s and two other hospitals compared surgical results of 178 patients with central lumbar spinal stenosis who were 80 and older with 1,325 patients who were 18 to 79 years old. The findings were published in the Journal of American Geriatrics Society in october 2016.
Researchers found both groups showed similar levels of sig- nificant improvement with no substantial differences in leg or back pain. As in the first study, the older group stayed longer in the hospital (4.5 days on average, compared with 3.2 days for the younger group), and the older group did report more complications three months following surgery, chiefly urinary tract infections.
older patients tend to have higher rates of chronic diseases, such as diabetes, high blood pressure and cardiovascular dis- ease, which can increase the risk of post-surgical complica- tions and lengthen hospital stays, Dr. Leppla said.
“the length of stay is likely to be longer,” for older patients with one or more chronic conditions, he said.
An earlier study supported by the u.S. national Institute of Arthritis and Musculoskeletal and Skin Diseases questioned the value of surgery for diabetic patients with spinal stenosis, herniated discs or degenerative spondylolisthesis, a condition that occurs when a vertebra moves forward out of alignment with the one below it. the study, published in Spine, was part of the federal Spine Patient outcomes Research trial (SPoRt), and looked at outcomes for 2,405 patients, of which 199 had diabetes, who underwent surgery for one of these conditions. In 2011, the institute reported the diabetic patients did not improve as much as other patients, older diabetic patients had more complications and that for diabetic patients with her- niated discs, non-surgical treatments seemed as effective as surgery.
How To Decide
the demand for spinal surgery – other than to treat emergen- cies – is patient-driven, Dr. Leppla said.
(continued on next page)


10
Cape Cod Health News
“Lower back pain is the second most common reason for visit- ing a primary physician,” he said.
If the pain is just in the lower back, it’s probably not caused by a herniated disc, Dr. Leppla said. A disc likely is to blame if the pain starts in the lower back and goes down the but- tock and leg on one side, a symptom called sciatica, after the sciatic nerve located in that area. usually a doctor will order a MRI to examine the lower back and will try other means, such as pain relievers, physical therapy, heat, exercise and steroid shots, before recommending surgery for a herniated disc, Dr. Leppla said. then, it’s up to the patient to seek surgery if pain and weakness don’t improve.
the exceptions would be emergency surgery for a patient who has lost control of their bladder or bowel, and surgery is recom- mended for a patient who has experienced worsening foot drop over a period of weeks, Dr. Leppla said.
Surgery would be ruled out for patients who recently had a heart attack, are on blood thinners for a year following implan- tation of drug-eluting stents in their coronary arteries, or have severe pulmonary disease, he added.
there is no set period of how many weeks or months patients should try non-surgical therapies before opting for surgery for a herniated disc. Dr. Leppla said he once had a professional golfer as a patient who wanted it done immediately because pain and weakness interrupted his busy schedule.
“If you’re miserable and you’re dragging your leg,” then con- sider surgery, he said. | CCHN
Falmouth Hospital is an institution that’s been woven into the fabric of the community for more than 50 years. our dedicated team provides the high-quality, compassionate, personalized care you can’t find anywhere else.
With our expert physicians, highly skilled staff and the latest in advanced technology, there’s no need to go any further than Falmouth Hospital to receive the best care and treatment. We are here 24 hours a day, 7 days a week,
close to home, caring for you.
We are Falmouth Hospital. Learn more at www.capecodhealth.org/we-are-FH


A News Service of
11
WoMen’S HeALtH
It took a team of dedicated and skilled medical professionals at Falmouth Hospital to bring Harper Borofski into the world on Friday, March 2018.
Her unusual delivery started earlier in the week when her mother, Megan Brown, who was 39 weeks pregnant at the time, had a nosebleed. When her nose started bleeding on tuesday of that week, she wasn’t overly concerned. But the bleeding didn’t stop.
on Wednesday, the 24-year-old Sagamore resident went to Stoneman urgent Care in Sandwich, where they referred her to otolaryngologist Douglas Mann, MD, at upper Cape ear, nose & throat in Falmouth.
“Dr. Mann saw me immediately which was amazing,” Brown said. “He was great.”
nosebleeds are common enough that Dr. Mann sees them al- most every day, he explained. But Brown’s nosebleed was out of the ordinary.
“I would say that 95 percent of the time you look in the nose and you can see exactly where the bleeding is coming from and you can control it fairly easily,” he said. “But Megan was in the five percent group where we didn’t see anything as an obvious source.”
Part of the difficulty was that Brown had a deviated septum. the wall between her nostrils was crooked and it was deviated on the left side, which is the side that was bleeding. Any time Dr. Mann did any kind of manipulation of her nose, it bled profusely. He thought that Brown would probably need surgery but, as a first line of defense, he put significant packing in her nose to apply pressure and hopefully stop the bleeding.
He then called Brown’s obstetrician, Paul DeMeo, MD, at Cape obstetrics & gynecology PC in Falmouth and Bourne to see if it was okay for Brown to have surgery, if necessary. He also wanted to share his concern that if Brown went into labor the exertion of pushing could cause her nose to start bleeding ex- cessively again.
“I got involved at that point because Dr. Mann wanted her admitted to maternity overnight for pain control because of the packing she had placed,” Dr. DeMeo said.
A nosebleed. A pregnancy.
A team effort.
A Falmouth Hospital team stepped into action with Megan Brown suffered a serious nosebleed late in her pregnancy.
By Laurie Higgins
Bleeding Started Again
When Brown returned to see Dr. Mann on Friday to have the packing removed, she immediately started bleeding again. He knew surgery was the only option and sent her back to Fal- mouth Hospital.
Luckily, Dr. DeMeo was already at the hospital that day. Dr. Mann consulted with Dr. DeMeo and his colleagues, obstetri- cians Phillip McCrary, MD, and elizabeth Murray, MD, along with anesthesiologist nina Zachariah, MD, about how to pro- ceed in the safest way for both mother and child.
The options were either to do general anesthesia to fix her nose and then do a caesarian section a few days later, or to do both the nose repair and the C-section at the same time.
“I didn’t want to subject my child to anesthesia twice,” Brown said. “I didn’t want her to go through my nose surgery and then four days later have to have a spinal to take her out. that didn’t seem fair to her and it was scary to me to think that she was going to be inside of me during surgery.”
Her doctors agreed and moved forward with the plan. Fal- mouth Hospital Chief Medical Officer, Alexander Heard, MD, who is also a pediatrician at Cape Cod Pediatrics in Forestdale, joined them, along with pediatrician giannina tierney, MD, from Bramblebush Pediatrics & Adolescents in Falmouth.
“We decided to do it in the main operating room because of the availability of all of Dr. Mann’s special instruments that he needs,” Dr. DeMeo said. “It made sense to do it there rather than try to bring all of those instruments up to maternity. If there was something else that they needed that they didn’t have, someone would have to run down and get it so, logisti- cally it was easier to do it in the main oR. We just had to coor- dinate that with the maternity staff, and they came down and brought all the instrumentation and the things that we needed to do the Caesarean to the main oR.”
the maternity and pediatric team was set up in an adjoin- ing operating room, along with Brown’s fiancé, Dylan Borofski. Four minutes after Dr. Zachariah administered anesthesia to Brown, Harper was born. She was then whisked off to the second operating room to meet her father.
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Cape Cod Health News
A Great Outcome
“What they did was beautiful,” Dr. Mann said. “I watched the C-section, which I have not done in my entire career since medical school. It was exciting to watch and to see how ex- pertly and quickly they got it all done.”
When Dr. DeMeo and Dr. McCreary finished their surgery, Dr. Mann began the repair on Brown’s nose. First, he straightened her septum so his vision wasn’t obstructed. once he did that, he could see that she had a hemangioma, which is a benign growth of a collection of abnormal blood vessels.
“Hemangiomas bleed easily and they bleed impressively,” said Dr. Mann.
He removed the hemangioma and sent it to pathology to be checked out, and cauterized the base of it to prevent it from bleeding again.
“everything turned out well and now she’s breathing better afterwards,” Dr. Mann said. “that’s a little plus.”
Brown couldn’t be happier about the care she received from the entire team.
“It was kind of like I got the Boston experience at Falmouth Hospital, which was amazing,” she said. “It was just the great- est experience from start to finish, even though I had to have surgery.” | CCHN
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We are Falmouth Hospital
Members of the Falmouth Hospital Auxiliary generously give their time as fundraisers to help make a difference in the lives of Falmouth Hospital patients. over the years, the Auxiliary has raised almost $6 million for facilities and programs that have enhanced the quality of healthcare on the upper Cape.
the Auxiliary supports Falmouth Hospital by:
• Managing and staffing the Thrift Shop and Gift Shop.
• Sponsoring fundraising events, speakers and special sales.
• Serving as community ambassadors to spread the word about the mission,
activities and services of the hospital.
Learn more at www.capecodhealth.org/we-are-FH
Auxiliary Board
Back row (L to R): nancy Leanues; Maureen Saunders; Muriel Locklin; Barbara McSherry; Susan o’grady; Winnie Fitzpatrick; Mary eason; Jim Mcgoldrick; Barbara Marshall; Virginia gray; Susan Hanley;
Linda McCann; Betty Hanson; Front row (L to R): Ann Vitullo;
Shirley Gallerani; Linda Quesnel; Kate Yelle; and Kathi Shaffer


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